BACKGROUND & AIMS: Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥ 0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection. METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI. RESULTS: In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001). CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.
BACKGROUND & AIMS:Participants at a consensus conference proposed defining cirrhosis-associated acute kidney injury (AKI) based on a >50% increase in serum creatinine level from the stable baseline value in <6 months or an increase of ≥ 0.3 mg/dL in <48 hours. We performed a prospective study to evaluate the ability of these criteria to predict mortality within 30 days of hospitalization among patients with cirrhosis and infection. METHODS: We followed up 337 patients with cirrhosis who were admitted to the hospital with an infection or developed an infection during hospitalization (56% men; 56 ± 10 years of age; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) at 12 centers in North America. We compared data on 30-day mortality, length of stay in the hospital, and organ failure between patients with and without AKI. RESULTS: In total, based on the consensus criteria, 166 patients (49%) developed AKI during hospitalization. Patients who developed AKI were admitted with higher Child-Pugh scores than those who did not develop AKI (11.0 ± 2.1 vs 9.6 ± 2.1; P < .0001) as well as higher MELD scores (23 ± 8 vs 17 ± 7; P < .0001) and lower mean arterial pressure (81 ± 16 vs 85 ± 15 mm Hg; P < .01). Higher percentages of patients with AKI died within 30 days of hospitalization (34% vs 7%), were transferred to the intensive care unit (46% vs 20%), required ventilation (27% vs 6%), or went into shock (31% vs 8%); patients with AKI also had longer stays in the hospital (17.8 ± 19.8 vs 13.3 ± 31.8 days) (all P < .001). Of the AKI episodes, 56% were transient, 28% were persistent, and 16% resulted in dialysis. Mortality was higher among those without renal recovery (80%) compared with partial (40%) or complete recovery (15%) or those who did not develop AKI (7%; P < .0001). CONCLUSIONS: Among patients with cirrhosis, 30-day mortality is 10-fold higher among those with irreversible AKI than those without AKI. The consensus definition of AKI accurately predicts 30-day mortality, length of hospital stay, and organ failure.
Authors: Carlos Terra; Mónica Guevara; Aldo Torre; Rosa Gilabert; Javier Fernández; Marta Martín-Llahí; Maria E Baccaro; Miquel Navasa; Conxita Bru; Vicente Arroyo; Juan Rodés; Pere Ginès Journal: Gastroenterology Date: 2005-12 Impact factor: 22.682
Authors: Mónica Guevara; Carlos Terra; André Nazar; Elsa Solà; Javier Fernández; Marco Pavesi; Vicente Arroyo; Pere Ginès Journal: J Hepatol Date: 2012-06-23 Impact factor: 25.083
Authors: P Sort; M Navasa; V Arroyo; X Aldeguer; R Planas; L Ruiz-del-Arbol; L Castells; V Vargas; G Soriano; M Guevara; P Ginès; J Rodés Journal: N Engl J Med Date: 1999-08-05 Impact factor: 91.245
Authors: Justin M Belcher; Guadalupe Garcia-Tsao; Arun J Sanyal; Harjit Bhogal; Joseph K Lim; Naheed Ansari; Steven G Coca; Chirag R Parikh Journal: Hepatology Date: 2012-12-06 Impact factor: 17.425
Authors: A Follo; J M Llovet; M Navasa; R Planas; X Forns; A Francitorra; A Rimola; M A Gassull; V Arroyo; J Rodés Journal: Hepatology Date: 1994-12 Impact factor: 17.425
Authors: Georgios I Tsiaoussis; Stelios F Assimakopoulos; Athanassios C Tsamandas; Christos K Triantos; Konstantinos C Thomopoulos Journal: World J Hepatol Date: 2015-08-18
Authors: Brian Erly; William D Carey; Baljendra Kapoor; J Mark McKinney; Mathew Tam; Weiping Wang Journal: Semin Intervent Radiol Date: 2015-12 Impact factor: 1.513
Authors: F Wong; J G O'Leary; K R Reddy; G Garcia-Tsao; M B Fallon; S W Biggins; R M Subramanian; P J Thuluvath; P S Kamath; H Patton; B Maliakkal; P Tandon; H Vargas; L Thacker; J S Bajaj Journal: Am J Gastroenterol Date: 2017-04-25 Impact factor: 10.864
Authors: Elliot B Tapper; Vilas Patwardhan; Laura M Mazer; Byron Vaughn; Gail Piatkowski; Amy R Evenson; Raza Malik Journal: J Gastrointest Surg Date: 2014-08-05 Impact factor: 3.452